Although hemihepatic portal vein embolization (PVE) has been used preoperatively to extend indications for hepatectomy in patients with colorectal metastases, the effects of this procedure on tumor growth and outcome remain controversial. To address this issue, we assessed the proliferative activity of intrahepatic metastases after PVE and the long-term outcome of this procedure. Eighteen patients with colorectal metastases underwent preoperative PVE between 1996 and 2000 (PVE group). Twenty-nine patients who underwent major hepatic resection without PVE served as control (non-PVE group). The hepatic parenchymal fraction of the left lobe had significantly increased from 38.1 ؎ 3.2% to 45.9 ؎ 2.9% 3 weeks after PVE (؉20.5%, P < .0001). Tumor volume and percent tumor volume had also significantly increased from 223 ؎ 89 mL to 270 ؎ 97 mL (؉20.8%, P ‫؍‬ .016) and from 13.7 ؎ 4.3% to 16.2 ؎ 4.9% (؉18.5%, P ‫؍‬ .014), respectively. There was no apparent correlation between the increase in parenchymal volume and that in tumor volume. The Ki-67 labeling index of metastatic lesions was 46.6 ؎ 7.2% in the PVE group and 35.4 ؎ 12.6% in the non-PVE group (P ‫؍‬ .013). Long-term survival was similar in the PVE and non-PVE groups, however, disease-free survival was significantly poorer in the PVE group than in the non-PVE group (P ‫؍‬ .004). We conclude that PVE increases tumor growth and probably is associated with enhanced recurrence of disease. Although PVE is effective in extending indications for surgery, patient selection for PVE should be cautious. (HEPATOLOGY 2001;34:267-272.)Hepatic resection provides the only chance for cure in patients with colorectal metastases. To extend indications for hepatectomy, hemihepatic portal vein embolization (PVE) has been performed in selected patients. 1-3 PVE induces homolateral atrophy of the portion of the liver scheduled for resection and contralateral compensatory hypertrophy of the remnant liver, thus decreasing the risk of postoperative liver failure. PVE is indicated when the remnant liver is expected to be very small, i.e., about 40% smaller than preoperative liver volume, or when tumor spread requires a right hemihepatectomy with partial resection of the left side of the liver. 4,5 The positive effects of PVE on hepatic function must be weighed against recent evidence suggesting that this procedure may promote oncogenesis. Elias et al., have reported that after PVE liver metastases may grow more rapidly than liver parenchyma. 6 This assumption was based on a study of only 5 patients who had tumors in the nonembolized lobe of the liver, rather than the embolized lobe. In addition, they focused on tumor growth in the nonembolized lobe. Consequently, their findings were considered too premature to warrant contraindication of PVE in patients with colorectal metastases. 7,8 When used in combination with arterial chemoembolization, PVE suppresses growth of hepatocellular carcinoma (HCC). 9 Long-term results of HCC resection after PVE have recently been shown to be better than or...

Tumour site, histological type and the presence of mesenteric lymph node metastasis are factors predicting the risk of lateral node metastasis. The poor prognosis of patients with lateral lymph node metastases after systematic lateral dissection suggests the need for adjuvant therapy.

Lateral lymphatic flow from low-lying rectal cancer passes outside the boundaries of total mesorectal excision but within the range of curative surgery by three-space dissection.

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Careful attention should always be paid to the second cancer in treating cancer patients. Further analysis by individual site of the index cancers is needed to construct an effective surveillance for second cancers.